Sometimes it would be nice to know for sure what's wrong with me. I'd love to have the full list of diagnoses that have been on my charts from time to time. When I was initially diagnosed it was "dysthymia with major depressive episodes". In laymen's terms, an ongoing mild depression that periodically intensifies into a major depression. Ok. I have also been labeled as having "major depressive disorder: non-responsive", as in he's depressed, but anti-depressants do not work.
But then my last two psychiatrists have thought differently. Apparently, it is common to misdiagnose someone as being depressed when they are in fact bipolar. The reason why the depression does not respond to anti-depressants, and continues to return, is that the person is cycling from a manic or hypo-manic state to a depressed state, and back again. Bipolar depression is less likely to respond to anti-depressants, though anti-depressants may be part of the treatment. Bipolar depression responds to mood stabilizers such as lithium or Lamictal.
I am convinced that I am bipolar because I have responded better to Lamictal than any of the anti-depressants that I have been put on, and I have been put on most of the common anti-depressants, and a few not so common ones. There is a reverse diagnosis going on here that I understand is common. There is no test to definitively diagnose bipolar. But if you respond to mood stabilizers, and not so much to anti-depressants, then you are likely bipolar.
Bipolar I is easier to diagnose because both the manic state and depressed state are extreme even to the point of being psychotic. Bipolar II is more difficult because there is not a "manic" state, but rather a hypomanic state, which is not as severe and may present itself as just a very high level of goal oriented, creative and productive, driven functioning. It is pleasurable. And then there is another category, mixed states. One can also experience both manic or hypomanic symptoms concurrently with depressed symptoms. It all muddies the waters.
My psychiatrist is using the diagnosis of Bipolar for me. My psychologist is not so sure. I find myself wondering if doctors are prejudiced in their diagnosis based on their specialization. Psychiatrists prescribe meds, and Bipolar responds to meds, so are they more inclined to diagnose someone as bipolar? Psychologists do therapy, and psychological disorders respond to things such as cognitive/behavioral therapy, hence are they more likely to diagnose accordingly. I don't know.
What I know is that I have continually cycled through highs and lows over the course of my life, and that they have progressed. The highs get higher, the lows get lower. Sometimes the shift between the two is gradual over time. Sometimes it is as violent as falling off a cliff. And sometimes, I experience a cluster of thoughts and behaviors that are concurrently depressed and hypo-manic.
If I am truly bipolar, as I believe I am, then if I go off my medication there is a good chance that a full blown manic state could be triggered. But the mood stabilizers seem to have me locked into a mildly depressed state, and quite frankly, when your best day is still depressed it is not fun.
I wish mental health issues were as clear as heart problems. When my mitral valve failed, they could hear the murmur. They could take pictures of the prolapse. They could go in and repair it. With a mental health problem, neither the diagnosis nor the cure is straight forward. There is a wide range of disagreement within the medical community. One doctor may be convinced that you clearly are bipolar and the next doctor convinced that you are not. And as a patient, I am left wondering. Is this the right diagnosis, and the correct treatment? Or are we all off track?
A dilemma indeed.
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